Citation NR: 9631892
Decision Date: 11/14/96 Archive Date: 11/22/96
DOCKET NO. 94-35 898 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Louisville,
Kentucky
THE ISSUE
Entitlement to service connection for headaches.
REPRESENTATION
Appellant represented by: Veterans of Foreign Wars of
the United States
WITNESSES AT HEARING ON APPEAL
Appellant and appellant's wife
ATTORNEY FOR THE BOARD
Nadine W. Benjamin, Counsel
INTRODUCTION
The veteran served on active duty from May 1968 to December
1969. This matter comes to the Board of Veterans’ Appeals
(Board) on appeal from rating decisions by the Department of
Veterans Affairs (VA) Regional Office (RO) in Louisville,
Kentucky.
In June 1996, the veteran appeared before the undersigned
member of the Board, and gave testimony in support of his
claim. Initially, the issues on appeal included entitlement
to an increased (compensable) evaluation for the veteran’s
service-connected bilateral defective hearing. At his
hearing, the veteran indicated that he wished to withdrawn
the issue of entitlement to an increased rating for bilateral
defective hearing.
REMAND
The veteran seeks service connection for migraine headaches,
which he argues are the result of acoustic trauma experienced
while in service. He reports that a charge landed beside him
while he was in a bunker, knocking him down. He states that
headaches began that night.
The service medical records show that at service entrance in
March 1968, the veteran gave a history of frequent or severe
headaches, and tension headaches were among the diagnoses.
There is no record of treatment for headache complaints
during service. He was treated in June 1969 for tinnitus and
decreased auditory acuity in the left ear after a charge
exploded near a bunker where the veteran was sitting. At
separation in December 1969, there were no complaints or
findings concerning headaches.
The veteran was examined by VA in June 1993. He gave a
history of headaches since 1970. The diagnosis was
headaches, possibly migraine. It was noted by the examiner
that no evaluation had been done in regard to the veteran’s
headaches. The examiner noted that the veteran had not had a
Computerized Tomography (CT) of the skull or an
electroencephalogram (EEG) for proper evaluation of the
headaches. It was noted that the diagnosis was based purely
upon the clinical history provided by the veteran, and that
further evaluation might be appropriate.
At his personal hearing, the veteran stated that he was
exposed to a blast during service which knocked him down and
that after that he developed headaches. He stated that after
service he was treated by several physicians for headache
complaints, including Dr. Benteen, in Ashland, Kentucky, Dr.
Thomas, in Flatwoods, Kentucky, and Dr. Smith in Ashland,
Kentucky. Treatment records have not been requested from
these physicians.
VA has a statutory duty to assist the veteran in the
development of facts pertinent to his claim. 38 U.S.C.A.
§ 5107(a) (West 1991 & Supp. 1995). That duty includes
obtaining medical records when deemed necessary. Murphy v.
Derwinski, 1 Vet.App. 78 (1990). This duty also includes
obtaining VA examinations when deemed necessary. Littke v.
Derwinski, 1 Vet.App. 90 (1990).
In view of the foregoing, the case is hereby REMANDED to the
RO for the following development:
1. The RO should contact the veteran and
request that he identify the names,
addresses and approximate dates of
treatment for all health care providers
who have treated him for headaches before
or after service. With any necessary
authorization from the veteran, the RO
should attempt to obtain copies of
pertinent treatment records identified by
the veteran which are not currently of
record. Of particular interest are
records from the three physicians noted
above.
2. Thereafter, the RO should schedule
the veteran for a VA neurological
examination by a board certified
neurologist, if available, to determine
the nature, extent and severity of the
veteran’s headache complaints. All
indicated tests and studies, including a
CT scan and an EEG, are to be conducted,
and all findings should be reported in
detail. The claims file and a copy of
this remand must be made available to
and reviewed by the examiner prior to the
requested study. The examiner is
requested to offer an opinion as to
whether it is at least as likely as not
that the veteran’s headache complaints
are related to his inservice exposure to
acoustic trauma. A complete rationale
for all opinions and conclusions
expressed should be given.
3. Following completion of the
foregoing, the RO must review the claims
folder and ensure that all of the
foregoing development actions have been
conducted and completed in full. If any
development is incomplete, including if
the requested examination does not
include all test reports, special studies
or opinions requested, appropriate
corrective action is to be implemented.
4. Thereafter, the RO should undertake
any other indicated development, review
all evidence of record, and readjudicate
the issue of entitlement to service
connection for headaches.
If the benefit sought on appeal is not granted to the
satisfaction of the veteran, a Supplemental Statement of the
Case should be issued, and the veteran and his representative
provided an opportunity to respond. Thereafter, the case
should be returned to the Board for further consideration, if
otherwise in order. By this
REMAND, the Board intimates no opinion as to any final
outcome warranted. No action is required of the veteran
until he is notified by the RO.
F. JUDGE FLOWERS
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of a
preliminary order and does not constitute a decision of the
Board on the merits of your appeal. 38 C.F.R. § 20.1100(b)
(1995).
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